Alameda Health System is hiring: Director of Medical Writing Projects in Oakland

100% employer health plan for employees and their eligible dependents ~ Rich and varied retirement plans and the ability to participate in multiple plans. ~ The Director of Utilization Management holds a critical role encompassing operational oversight, strategic planning, compliance, and collaboration. Their responsibilities span from managing admissions to ensuring clean claims, identifying trends, and optimizing resource utilization. In essence, they orchestrate efficient utilization management to deliver high-quality patient care. Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. Monitor and evaluate the utilization of healthcare services, including appropriateness, efficiency, and medical necessity of treatments and procedures. Analyze data and generate reports on utilization trends, outcomes and quality indicators to support decision-making and process improvement initiatives. Manage quality of performance criteria, policies and procedures, and service standards for the utilization management operations. Develop and implement utilization review policies and procedures in accordance with industry standards and regulatory requirements. Direct and coordinate data gathering and record keeping legally required by federal and state agencies, the Joint Commission, and hospital policies; participates in the risk mitigation, process of implementing new or revised processes, and projects Participate in interdisciplinary committees and meetings to contribute to the development and implementation of quality improvement initiatives. Maintains minimal denial rates by Medicare, MediCal, private and contracted payers through appropriate direction of utilization practices; assists physicians and hospital personnel in understanding UM matters. Prepares cost analysis reports and other data needed for the preparation of the departmental budget. Provides in-house educational programs as needed for both staff and physicians. Responsible for the recruitment, orientation, evaluation, counseling and disciplinary action of UM and administrative staff. Serves as a content expert to staff and internal departments and external partners; networks with other hospitals, nursing organizations, and professional organizations to keep abreast of changes within the profession. Bachelors degree in Nursing Health insurance company and/or acute care hospital, post-acute and psych; Preferred Licenses/Certifications : UM / CM certifications Highland General Hospital SYS Utilization Management Full Time